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AEROSPACE NEWS

CMS Selects Finalists for Medicare Claims Processing Contract

Key Takeaways
  • CMS selects HealthEdge and Peraton for Medicare claims processing contract.
  • Contract has a potential seven-year duration.
  • ClaimsCore system to support 2 million active users and process 100,000 claims daily.
  • HealthEdge's portion has a $2.5 billion initial obligation and $1.1 billion ceiling.
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Strategic Implications

This selection may indicate CMS' focus on modernizing legacy systems and improving payment integrity. The choice of HealthEdge and Peraton suggests a preference for companies with experience in healthcare IT, which could lead to more efficient claims processing and reduced provider burdens.

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What Happened

HealthEdge and Peraton Advance in Seven-Year Competition

The Centers for Medicare and Medicaid Services has chosen HealthEdge and Peraton to move forward in a competition for a potential seven-year contract to help stand up a new software system for processing and adjudicating Medicare claims. The ClaimsCore system aims to support over 2 million active users and process more than 100,000 claims per day, replacing four legacy systems built in the 1970s. HealthEdge’s portion of the contract has an initial $2.5 billion obligation and a $1.1 billion ceiling, while Peraton’s allocation was initially obligated $9.1 million with a potential value of $825 million. The final decision is expected by January 1, 2027, as reported by Washington Technology.

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JUMPSEAT
AEROSPACE NEWS
JUMPSEAT
AEROSPACE NEWS

CMS Selects Finalists for Medicare Claims Processing Contract

Sponsored by: Jumpseat Solutions
Key Takeaways
  • CMS selects HealthEdge and Peraton for Medicare claims processing contract.
  • Contract has a potential seven-year duration.
  • ClaimsCore system to support 2 million active users and process 100,000 claims daily.
  • HealthEdge's portion has a $2.5 billion initial obligation and $1.1 billion ceiling.
Sign in to view key takeaways Get full access to in-depth analysis and key takeaways.
Sign In
Silver membership required Upgrade to Silver to access Key Takeaways.
Upgrade
Strategic Implications

This selection may indicate CMS' focus on modernizing legacy systems and improving payment integrity. The choice of HealthEdge and Peraton suggests a preference for companies with experience in healthcare IT, which could lead to more efficient claims processing and reduced provider burdens.

Sign in to view strategic implications Get full access to strategic analysis and expert insights.
Sign In
Silver membership required Upgrade to Silver to access Strategic Implications.
Upgrade

What Happened

HealthEdge and Peraton Advance in Seven-Year Competition

The Centers for Medicare and Medicaid Services has chosen HealthEdge and Peraton to move forward in a competition for a potential seven-year contract to help stand up a new software system for processing and adjudicating Medicare claims. The ClaimsCore system aims to support over 2 million active users and process more than 100,000 claims per day, replacing four legacy systems built in the 1970s. HealthEdge’s portion of the contract has an initial $2.5 billion obligation and a $1.1 billion ceiling, while Peraton’s allocation was initially obligated $9.1 million with a potential value of $825 million. The final decision is expected by January 1, 2027, as reported by Washington Technology.

Source

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